title: Feasibility and safety of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis for severe ulcerative colitis.
abstract: BACKGROUND
  The laparoscopic approach is accepted as a treatment option for patients with ulcerative colitis (UC) who are otherwise in good health. However, its application for patients with severe UC remains controversial. The purpose of this study was to evaluate the feasibility of the laparoscopic approach for severe UC cases. Short- and long-term clinical outcomes after laparoscopic total proctocolectomy with ileal pouch-anal anastomosis were compared between severe and mild-to-intermediate UC patients.
  
  
  METHODS
  Cases treated between March 2002 and September 2010 were retrieved retrospectively from the database of Kyoto Medical Center and Kyoto University Hospital. Intraoperative complications and short- and long-term clinical outcomes were compared.
  
  
  RESULTS
  A total of 31 patients underwent laparoscopic total proctocolectomy with ileal pouch-anal anastomosis. A comparison of short- and long-term clinical outcomes after one- or two-stage laparoscopic ileal pouch-anal anastomosis between severe (n = 7) and mild-to-intermediate (n = 21) UC patients revealed no significant differences. The proportion of patients with restoration of intestinal continuity did not differ between the groups (severe: 86%, mild to intermediate: 95%; P = 0.69).
  
  
  CONCLUSIONS
  The present findings suggest that laparoscopic total proctocolectomy with ileal pouch-anal anastomosis for severe UC patients could be a good alternative approach when performed by an experienced hand.
authors.affiliation: Department of Surgery, Kyoto University, Kyoto, Japan; Department of Surgery, Shiga Medical Center for Adults, Moriyama, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Kawamura
authors.forename: Suguru
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Kawada
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagayama
authors.forename: Ryo
authors.initials: R
authors.lastname: Matsusue
authors.forename: Akinari
authors.initials: A
authors.lastname: Nomura
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sakai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D001706:Biopsy; D002915:Chylous Ascites / Q000453:epidemiology; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery*; D039021:Colonic Pouches; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Inflammatory bowel disease; laparoscopy; ulcerative colitis